| NPI | 1366433005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1087146) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 111777) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2024-12-19 |